title: The medical treatment of Cushing's disease: effectiveness of chronic treatment with the dopamine agonist cabergoline in patients unsuccessfully treated by surgery.
abstract: BACKGROUND
  The role of dopamine agonists in the treatment of Cushing's disease (CD) has been previously debated.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effectiveness of short-term (3 months) and long-term (12-24 months) treatment with cabergoline in patients with CD.
  
  
  METHODS
  20 patients with CD unsuccessfully treated by surgery entered the study. Cabergoline was administered at an initial dose of 1 mg/wk, with a monthly increase of 1 mg, until urinary cortisol levels normalized or the maximal dose of 7 mg/wk was achieved. The responsiveness to treatment was evaluated according to changes in urinary cortisol excretion. A decrease greater than 25% was considered as a partial response, whereas complete normalization was considered as a full response at short-term evaluation; persistence of normal cortisol excretion was the only criterion to evaluate the response at long-term evaluation.
  
  
  RESULTS
  After short-term treatment, 15 (75%) patients were responsive to cabergoline treatment. Among these, normalization of cortisol excretion was maintained in 10, whereas treatment escape was observed in five patients after 6-18 months. Among the 10 long-term responsive patients, eight were followed for 24 months, whereas the remaining two were followed for 12-18 months, due to cabergoline withdrawal for intolerance. A sustained control of cortisol secretion for 24 month cabergoline treatment at the maximal dose ranging from 1-7 mg/wk (median: 3.5) without significant side effects, was obtained in eight of 20 (40%) patients.
  
  
  CONCLUSIONS
  The results of this study demonstrated that cabergoline treatment is effective in controlling cortisol secretion for at least 1-2 yr in more than one third of a limited population of patients with CD. If this evidence is confirmed by additional studies, this agent may be considered as a useful treatment option in patients with CD who are unsuccessfully treated by neurosurgery.
authors.affiliation: Department of Molecular and Clinical, Endocrinology, "Federico II" University, Via Sergio Pansini, 5, 80131 Naples, Italy. rpivone@tin.it
authors.forename: Rosario
authors.initials: R
authors.lastname: Pivonello
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: De Martino
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
authors.forename: Monica
authors.initials: M
authors.lastname: De Leo
authors.forename: Antongiulio
authors.initials: A
authors.lastname: Faggiano
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lombardi
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Hofland
authors.forename: Steven W J
authors.initials: SW
authors.lastname: Lamberts
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004873:Ergolines / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism / Q000652:urine; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D000324:Adrenocorticotropic Hormone; D000077465:Cabergoline; D006854:Hydrocortisone